Individual
MARIANNE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4225 NW AMERICAN LN, LAKE CITY, FL 32055-4881
(386) 758-6141
Mailing address
1007 PINE AVE SW, LIVE OAK, FL 32064-4021
(386) 362-7822
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0003034
FL
Other
Enumeration date
02/07/2007
Last updated
07/08/2007
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